Belching, or burping, refers to the noisy release of air or gas from the stomach through the mouth. Unpleasant abdominal fullness or distention is called bloating. Flatulence is the passage of excessive amounts of intestinal gas, or flatus, through the anus.
As much as 7% of the general population complains of excessive or bothersome belching and 11% report frequent bloating. Normal people pass gas (flatus), on average, ten times each day. Passage of gas up to twenty times daily is still considered normal.
There are several important factors that influence gas related symptoms. These include the amount of air that is swallowed; the efficiency with which the gastrointestinal tract moves and expels the air or gas; and the amount of gas that is produced by the bacteria living in the colon that act on incompletely digested food. There are also individual differences in sensitivity or tolerance to normal amounts of retained gas or the passage of a normal amount of flatus.
It is clear that some individuals swallow too much air into the stomach. Eating quickly, gulping food or beverages, and other habits such as drinking through a straw, chewing gum, sucking on hard candy or wearing loose fitting dentures may contribute to excessive air swallowing. People also swallow more frequently, and swallow more air, when they are nervous. Air can also be swallowed and released voluntarily as many people are able to belch at will. In some people, excessive belching has become a learned behavior, or habit, that initially may have been associated with some relief of indigestion symptoms, but now continues almost unconsciously.
The air that is swallowed and not removed by belching will pass through the digestive tract and eventually pass as flatus from the rectum. In normal people, about 50% of the gas passed from the rectum comes from swallowed air, and this amount can increase significantly in those individuals who swallow air excessively. Surprisingly, most people who experience excessive bloating and flatulence do not swallow or produce excessive gas. In these individuals, it seems that the movement of swallowed air, from the stomach toward the rectum, is much slower than normal. Additionally, the gas may sometimes move the wrong way, returning to the stomach. So, in spite of the fact that the amount of gas may be normal, people can experience bloating and "gas" because the gas is not moved efficiently, and it may accumulate, causing discomfort from the increased stretching of the bowel walls.
Some people have difficulty digesting certain foods completely. This can lead to partially digested food passing from the small intestines to the colon. There are a large number of bacteria in the colon that will readily "digest" the food further and produce gases in the process. Foods that contain certain sugars that are very difficult for most people to digest include the well-known gas-forming foods such as baked beans, lima beans and lentils. Most people also have difficulty properly digesting commonly added sweeteners such as fructose and sorbitol. Some people (particularly adults of Asian, African and Southern European descent) have difficulty digesting lactose (milk sugar) because they do not make enough of the enzyme, lactase, which is needed to breakdown lactose. If there is a large amount of lactose in their diet, then the incompletely digested lactose will pass to the colon where bacteria break it down and produce gas.
It is also thought that there are differences between individuals in their sensitivity to intestinal stretching from gas, and their tolerance for gas related symptoms. The sensitivity of the gastrointestinal tract and the severity of symptoms tend to increase as the amount of stress increases.
There are some prescription medications that purposefully inhibit digestive enzymes (e.g. acarbose) and others that contain indigestible sugars (lactulose and sorbitol) to accomplish their intended effect. These medications will often cause gas-related symptoms.
Rarely, patients can have a serious underlying disease of the digestive tract, such as celiac disease (gluten intolerance), dumping syndrome or pancreatic insufficiency that is the cause of their gas symptoms. These conditions may lead to improper digestion of food and result in excessive diarrhea, flatulence and finally, malnutrition and weight loss.
By themselves, gas-symptoms are not worrisome or indicative of any underlying serious condition. A visit to the doctor may be helpful if the symptoms are very bothersome and there are other associated symptoms that may benefit from further testing and or treatment. Symptoms that should be further evaluated by a doctor include abdominal pain, vomiting, diarrhea, constipation, weight loss, bleeding from the gastrointestinal tract and sometimes heartburn.
Currently, there are few clinical tests (other than the history obtained from the patient and a physical examination) that are used to further assess gas symptoms. In some cases, endoscopy (the insertion of a small lighted flexible tube through the mouth into the esophagus and stomach) may be helpful if ulcer disease or reflux disease is suspected, or sigmoidoscopy or colonoscopy (insertion of a similar tube into the rectum and colon) if there are associated changes in the bowel patterns. An x-ray of the abdomen may be performed if blockage of the intestines needs to be excluded. Sometimes lactose intolerance should be assessed with a trial of a lactose free diet for two weeks, or with a special blood or breath test. There are also simple blood tests available to screen for celiac disease (gluten sensitivity) if there are other features to suggest this disorder.
Sometimes excessive belching is associated with gastroesophageal reflux disease (GERD), and treatment of this condition may alleviate bothersome burping. Anti-gas medications, such as simethicone, are generally useless for excessive belching. Lifestyle modification such as avoidance of rapid eating, chewing gum, carbonated beverages and stopping smoking are often recommended but the response is variable. When simple reassurance and lifestyle modifications are not satisfactory, then psychological treatments such as relaxation therapy or behavioral therapy are currently the most useful approaches.
Bloating and flatulence are sometimes related to constipation, and treating the underlying condition may be helpful. After other conditions, such as lactose intolerance, have been excluded, a low gas-forming diet should be recommended. The diet excludes poorly digested foods such as the Brassica vegetables (brussels sprouts, turnip, grape, mustard and cabbage, as well as beans and lentils. Foods (including any drink, candy, gum or breath freshener) that contain sorbitol and added fructose should also be avoided. Fiber supplements and a high fiber diet can aggravate bloating symptoms, and should be discontinued if there is no benefit. A diet containing rice flour is fully absorbed in the small intestines and so produces the least amount of gas. There are several over-the-counter medications to treat gas-related symptoms including simethicone, activated charcoal and beano. Unfortunately, none of these products are very effective.
(Larry Szarka, M.D., Mayo Graduate School of Medicine, Rochester, Minnesota Michael Levitt, M.D., Veteran Affairs Medical Center, Minneapolis, Minnesota)
1. What are the gas-related symptoms?
2. How common are gas symptoms?
3. What are the causes of gas symptoms?
4. Can a person swallow too much air?
5. How does some foods lead to excess go?
6. Can certain medications cause excess gas?
7. Can excess gas mean there is a serious problem?
8. What treatments are available for the gas-related symptoms?
II. Fill in the gaps with the prepositions in the box:
| of, through, in, by, with, up, after, from, to, into |
Flatulence
Flatulence is the sensation … an increased amount … gas … the digestive tract.
Increased amounts … gas can gather … the stomach or farther along the digestive tract. Excess gas is expelled … the mouth (belching) or … the anus (known colloquially as farting and called flatus … doctors), or it is absorbed … the walls … the digestive tract … the blood and then excreted … the lungs. Bacteria … the digestive system also break down (metabolize) some gases.
Air is a gas, which can be swallowed … food. Swallowing small amounts … air is normal, but some people unconsciously swallow large amounts (aerophagia), especially when they feel anxious. Most swallowed air is later belched …, so only some air passes … the stomach … the rest … the digestive system. Swallowing large amounts … air may make a person feel full, and the person may belch excessively or pass the air … the anus.
Other gases are produced … the digestive system … several means. Hydrogen, methane, and carbon dioxide are produced … bacterial metabolism … food … the intestine, especially after a person eats certain foods such as beans and cabbage. People who have deficiencies … the enzymes that break down certain sugars also tend to produce large amounts … gas when they eat foods containing these sugars. Lactase deficiency, tropical sprue, and pancreatic insufficiency all may lead … the production … large amounts … gas. People … irritable bowel syndrome do not produce large amounts … gas, although the passage … normal volumes … gas … the bowel may be changed. Almost anyone who eats large amounts … proteins or fruits will develop some degree … flatulence.
III. Make the sentences complete:
Symptoms.
 |
1. Flatulence is often associated a. developing any symptoms.
with …
2. Some people are particularly b. tightness in the chest and stomach.
sensitive to …
3. Others can tolerate large amounts c. odor.
without …
4. Belching occurs shortly after … d. the effects of gas in the digestive system.
5. Drinking carbonated beverages
sometimes leads to … e. belching.
6. Before belching some people feel …
7. This sensation is relieved as … f. anus more than 10 times a day.
8. People normally pass gas through the …
9. Gas passed through the anus may g. pass excessive amounts of gas.
or may not have …
10. Infants with crampy abdominal pain h. abdominal pain and bloating.
sometimes …
i. gas is expelled.
j. eating and during periods of stress.
IV. Look through the text and speak about the treatment of flatulence using the scheme:
Treatment of flatulence
Bloating and belching are difficult to relieve. If belching is the main problem, reducing the amount of air being swallowed can help, which is difficult because people generally are not aware of swallowing air. Avoiding chewing gum and eating more slowly in a relaxed atmosphere may help.
People who belch or pass gas excessively may need to change their diet by avoiding foods that are difficult to digest. Discovering which foods are causing the problem may require eliminating one food or one group of foods at a time. A person can start by eliminating milk and dairy products, then fresh fruits, and then certain vegetables and other foods. Avoiding carbonated beverages helps some people.
Although drugs generally are not very effective, simethicone, which is present in some antacids and is also available separately, can provide a little relief. Sometimes other drugs—including other types of antacids, metoclopramide, and bethanechol— may help. Aromatic oils help some people, especially those who experience cramps with flatulence. Eating more fiber helps some people but worsens the symptoms in others. Charcoal tablets do not decrease flatulence but help reduce its offensive odor.
V. Listen to the text “Belching” and retell it in Russian.
VI. Give Russian equivalents to the following word-combinations:
· excessive belching
· to alleviate bothersome burping
· frequent bloating
· to pass gas as flatus from the rectum
· to swallow air unconsciously
· to expel gas
· retention of gas
· to release air voluntarily
· stretching of the bowel walls
· to treat underlying condition
· to make a person feel full
VII. Render from Russian into English:
Отрыжка.
Отрыжка- это внезапное непроизвольное* выделение газов из желудка или пищевода через рот, иногда с примесью содержимого желудка. Газ в желудке может скапливаться в результате попадания воздуха во время торопливой еды, с газированными напитками*, при еде всухомятку*. Небольшие количества газа постоянно образуются в полости желудка при переваривании пищи. Таким образом, в желудке всегда имеется определенное количество газов, играющих важную роль в пищеварении. У здоровых людей часть воздуха из желудка выделяется через рот без отрыжки, другая часть воздуха переходит в кишечник. Избыточное заглатывание воздуха повышает давление в желудке, способствует резкому сокращению его стенки, вызывая отрыжку. В таких случаях она бывает непостоянной, не имеет ни запаха, ни вкуса, не является симптомом какого- либо заболевания, проходит при нормальном питании.
Постоянная отрыжка возникает при длительной задержке пищи в желудке в результате нарушения его двигательной функции (сужения или спазма привратника). Отрыжка может быть симптомом заболевания желудка, печени, желчного пузыря, кишечника, диафрагмы. Иногда может проявляться при сердечно-сосудистых заболеваниях.
При появлении постоянной отрыжки необходимо проконсультироваться с врачом. Устранение отрыжки связано с лечением основного заболевания.
Vocabulary:
всухомятку - есть всухомятку = to eat cold food; to live on dry rations [ræ∫nz]
непроизвольный- involuntary
газированные напитки- carbonated beverages [΄bevəridʒiz]
Метеоризм
Метеоризм - это вздутие живота вследствие избыточного скопления газов в кишечнике. В желудке и кишечнике здорового человека всегда содержится небольшое количество газов, необходимого для поддержания нормального тонуса этих органов. Количество газов зависит от характера пищи, физической нагрузки и других факторов.
Газы попадают в пищеварительную систему при заглатывании воздуха и образуются в кишечнике в результате химических реакций и ферментативных процессов.
Метеоризм может возникнуть у вполне здорового человека после чрезмерного употребления некоторых продуктов. Однако метеоризм может быть и симптомом различных патологических состояний: при сдавлении или спазмах кишечника, его атонии, спайках брюшины. Метеоризм может появиться при хроническом гастрите, панкреатите, холецистите, энтерите.
Метеоризм проявляется чувством распирания и тяжести, урчанием *, схваткообразными болями в животе, которые проходят после отхождения газов. Иногда боли такие сильные, что сопровождаются холодным потом,
болями в сердце, и даже обмороками. Возможны икота*, отрыжка, головные боли.
У практически здорового человека метеоризм не требует специального лечения. Если преобладают гнилостные процессы, количество белка в рационе, сокращают.
Vocabulary:
урчание- rumbling; урчание в желудке разг. – tummy- rumbling [΄rΛmbliŋ]
икота- hiccup [΄hikΛp]
hiccough [΄hikɔf]
Part 3
Laryngitis
I. Look at the picture of larynx and give the names to the cartilages of the larynx:
| corniculate [kɔ:΄nikjulit] trachea [trə΄kiə] hyoid bone [΄haiɔidbəun] arytenoids cartilage [ˌæri΄ti:nɔid ka:tilidʒ] cricoid [΄kraikɔid] epiglottis [ˌepi΄glɔtis] thyroid [θairɔid] cuneiform [΄kju:niifɔ:m] |
Larynx is the organ responsible for the production of vocal sounds, also serving as an air passage conveying air from the pharynx to the lungs. It is situated in the front of the neck, above the trachea. It is made up of a framework of nine cartilages bound together by ligaments and muscles and lined with mucous membrane. Within are pair of vocal cords, which function in the production of voice.
II. Read the text “Laryngitis” and answer the questions follow it:
Laryngitis
Laryngitis is an inflammation of the larynx. It causes hoarse voice or the complete loss of the voice because of irritation to the vocal folds (vocal cords). Laryngitis is categorized as acute if it lasts less than a few days. Otherwise it is categorized as chronic, and may last over 3 weeks.
Causes
· viral infection
· bacterial or fungal infection
· inflammation due to overuse of the vocal cords
· excessive coughing, smoking, or alcohol consumption
Symptoms
Symptoms of laryngitis vary, depending on the severity and also the cause. The most common, and obvious, symptom is impaired speech, ranging from a raspy hoarseness to the total loss of ability to speak, except at a whisper. Other symptoms can include:
· Dry, sore throat
· Coughing, which can be a symptom of, or a factor in causing laryngitis;
· Difficulty swallowing;
· Sensation of swelling in the area of the larynx;
· Cold or flu-like symptoms (which, like a cough, may also be the causing factor for laryngitis;)
· Swollen lymph glands in the throat, chest, or face;
· Fever
Treatment
In most instances, the symptoms accompanying laryngitis are more directly linked to the causative factor, such as infection. In cases caused by overuse of the voice, symptoms other than vocal impairment may be absent. Laryngitis, hoarseness or breathiness that lasts for more than two weeks may signal a voice disorder and should be followed up with a voice pathologist. This is typically a vocology certified SLP (speech language pathologist) or a laryngologist (voice specialized ENT).
· If laryngitis is due to gastroesophageal reflux:
· The patient may be instructed to take a medication such as Zantac or Prilosec for a period of 4-6 weeks.
· If laryngitis is due to a bacterial or fungal infection the patient may be prescribed a course of antibiotics or anti-fungal medication.
· If persistent hoarseness or loss of voice (sometimes called "laryngitis") is a result of vocal cord nodules:
· Physicians may recommend a course of treatment that may include a surgical procedure and/or speech therapy.
· Reduction of high-impact stress to the vocal cords caused by loud, frequent, and high pitched voicing is recommended.
Find the answers to the following questions:
1. What is laryngitis?
2. What are the manifestations of the disease?
3. What causes laryngitis?
4. What is the choice of treatment?
III. Fill in the gaps with the words in the box:
|
cigarette smoke can cause short-lived ^acute) or persistent
The most common cause of laryngitis is a _1__ infection of the _ _2___ airways such as common cold. Laryngitis also may accompany __ 3___ or any other inflammation or infection of the upper airways. Excessive use of _ 4__, an allergic reaction, and inhalation of _ 5__ such as cigarette smoke can cause short-lived (___ 6___) or persistent (__ 7___) laryngitis. Bacterial infections of the larynx are extremely __ 8___.
Symptoms are an unnatural change of voice, such as __ 9___, or even __ 10___ of voice that develops within hours to a day or so. The throat may__ 11__ or feel __ 12__, and a person may have a constant urge __ 13__ the throat. Symptoms vary with the __14___ of the inflammation. Fever, a general __ 15__, difficulty in __16__, and a __17__ throat may occur in severe infections.
IV. Make the sentences complete:
| 1. A diagnosis of laryngitis is based on … 2. A doctor looks down the throat with… 3. On examination, the doctor may reveal … 4. Because cancer of the larynx may cause hoarseness, … 5. Treatment of viral laryngitis depends on … 6. Symptoms may be relieved by … 7. Whispering may … 8. Treatment of bronchitis, if present, may... 9. An antibiotic is given only for … | a) irritate the larynx even more |
| b) infection caused by bacteria | |
| c) a mirror or a thin, flexible viewing tube | |
| d) symptoms | |
| e) some reddening and some swelling of the lining of the larynx | |
| f) voice changes and typical symptoms | |
| g) resting the voice, drinking extra fluids, and inhaling steam | |
| h) a person with persistent symptoms should be evaluated for cancer | |
| i) improve laryngitis |
V. Listen to the text “Laryngitis”, retell it in Russian:
Vocabulary:
vocal folds = vocal cords
vibrance [vaibrəns] – вибрация
husky [hΛski] – сиплая, охрипшая вибрация; huskiness - хрипота
harsh [ha:∫] – грубый, жесткий, шероховатый
honking [hɔŋkiŋ] – резкий, бесчувственный
VI. Give Russian equivalents to the following word combinations:
· to cause hoarseness of the voice
· irritation of the vocal folds
· to lose vibrance
· husky voice
· honking cough
· to rest the voice
· steam inhalations
· the throat may tickle
· a constant urge to clear the throat
· excessive use of the voice= overuse of voice
· sore throat
· difficulty in swallowing
· to be irritated by whispering
· the throat may feel raw
VII. Render from Russian into English:
Ларингит.
Ларингит – это воспаление слизистой оболочки гортани. Различают 2 вида ларингита: острый и хронический.
Острый: ларингит часто возникает при остром катаре верхних дыхательных путей, гриппе, кори, скарлатине, коклюше и др. Его развитию способствует общее или местное переохлаждение, вдыхание холодного воздуха через рот, перенапряжение голоса, вдыхание запыленного воздуха, раздражающих газов и паров, очень холодные или очень горячее питье, курение, злоупотребление спиртными напитками.
При остром ларингите больные жалуются на ощущение сухости, першения, царапанья в горле. Кашель вначале может быть сухой, а затем с выделением мокроты. Голос хриплый, грубый и беззвучный. Иногда появляется боль при глотании, головная боль и небольшое повышение температуры.
Лечение острого ларингита состоит в устранении причин заболевания. Больному не рекомендуется разговаривать 5-7 дней для полного покоя гортани. Из лечебных процедур полезны теплое питье, полоскание горла, теплые ингаляции. Продолжительность болезни при соблюдении режима, назначенного врачом, не превышает 7-10 дней.
Хронический ларингит развивается как следствие рецидивирующегося острого ларингита или длительных воспалительных процессов в носу, глотке и придаточных пазухах. Заболеванию способствует курение, злоупотребление алкоголем и перенапряжение голоса. При хроническом ларингите больные жалуются на хрипоту, ощущение саднения, першения в горле с постоянным покашливанием. При обострении воспалительного процесса эти явления усиливаются. Хронический ларингит часто развивается как профессиональная болезнь у педагогов.
Therapy.
Otitis Media
I. Master the pronounciation:
otitis media [ɔ΄taitis ΄mi:diə] – отит среднего уха
eustachian tube [ju:s΄teikiən tju:b] – евстахиева труба
mastoiditis [ ֽ mæstɔi΄daitis] – мастоидит
eardrum [΄iədrΛm] – барабанная перепонка
myringotomy [ˌmiriŋ΄gɔtəmi] – миринготомия(рассечение барабанной перепонки)
tympanoplasty [ˌtimpæ΄nɔpla:sti] – тимпанопластика(пластика звукопроводящего аппарата среднего уха)
cholesteatoma [kəˌlestiə΄toumə] – холестеатома, жемчужная опухоль
ossicle [΄ɔsikl] – мелкая кость
polyp [΄pɔlip] - полип
II. Read the text “Understanding Otitis Media”
Understanding Otitis Media - the Basics
Otitis media, sometimes referred to simply as a middle ear infection or inflammation, is the most common cause of earaches. Although this condition is a frequent cause of infant distress and is often associated with children, it can also affect adults.
The infection in the middle ear (where tiny bones pick up vibrations from the eardrum and pass them along to the inner ear) very often accompanies a common cold, the flu, or another type of respiratory infection. This is because the middle ear is connected to the upper respiratory tract by a tiny channel known as a eustachian tube.
Most parents are frustratingly familiar with otitis media. Except for wellness baby visits, ear infections are the most common reason for trips to the pediatrician, accounting for approximately 30 million doctor visits a year in the U.S. Today, almost half of all antibiotic prescriptions written for children are for otitis media, and the cost of treating middle ear infections in the U.S. has been estimated at $2 billion a year. Untreated, otitis media can lead to more serious complications, including mastoiditis (a rare inflammation of a bone adjacent to the ear), hearing loss, perforation of the eardrum, meningitis, facial nerve paralysis, and possibly Meniere's disease.
Cells in the middle ear make a fluid that, among other things, help keep out invading organisms. Normally, the fluid drains out through the eustachian tube and into the throat. But if the eustachian tube becomes swollen, the fluid can become trapped in the middle ear, forming a breeding ground for bacteria that can cause the area to become inflamed and infected. This tube lies in a more horizontal position and is shorter in children, which may put them at even greater risk of infection. To the doctor, the eardrum of an infected patient appears red and bulging.
The most common cause of otitis media is an upper respiratory viral infection, such as a cold or the flu. These disorders can make the eustachian tube so swollen that middle ear fluid cannot drain. Allergies - to pollen, dust, animal dander, or food - can produce the same effect, as can smoke, fumes, and other environmental toxins. Bacteria can cause otitis media directly, but usually these organisms come on the heels of a viral infection or an allergic reaction, quickly finding their way into the warm, moist environment of the middle ear. Invading bacteria can wreak major havoc, turning inflammation into infection and provoking fevers. Among the bacteria most often found in infected middle ears are the same varieties responsible for many cases of sinusitis, pneumonia and other respiratory infections. (Note: Flu shots do not offer protection from otitis media.)
Otitis media occurs in various degrees of severity. A single, isolated case is called acute otitis media. If the condition clears up but comes back as many as three times in a six-month period (or four times in a single year), it is known as recurrent otitis media. This usually indicates the eustachian tube isn't working right. If it continues for weeks without clearing up, it is called chronic otitis media. A fluid buildup in the ear without infection is termed serous otitis media.
In recent years, scientists have identified the characteristics of people most likely to suffer recurrent middle ear infections: males; individuals with a family history of ear infections; babies who are bottle-fed (breastfed babies get fewer ear infections); children in day care centers; people living in households with tobacco smokers; and people with poor or damaged immune systems or chronic respiratory diseases such as cystic fibrosis and asthma.
· to wreak[ri:k] – давать выход, волю
havoc[΄hævɔk] – опустошение, разрушение
III. Make the sentences complete:
Acute Otitis Media
| 1. Acute otitis media is … 2. It results from infection as a complication of … 3. It is more common in … 4. Symptoms and treatment are similar in … 5. The infected ear is … 6. If a person has severe or persistent pain and fever, a doctor … 7. People, who have repeated bouts of otitis media may need … 8. Most people with acute otitis media get better … 9. However, most doctors treat all people with … 10. Nonsteroidal anti – inflammatory drugs … 11. Decongestants … 12. Anti – histamines are useful for people who have allergies but … | a)adults and older children |
| b)on their own | |
| c)containing phenylephrine may help | |
| d)the common cold or allergies | |
| e)to have tympanostomy tubes placed in their eardrums | |
| f)painful, with a red bulging eardrum | |
| g)can relieve pain | |
| h)a bacterial or viral infection of the middle ear | |
| i)antibiotics, such as amoxicillin | |
| j)not for patients with colds | |
| k)children than in adults | |
| l)may perform a myringotomy |
IV. Fill in the gaps with prepositions:
|
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